Enlarged Lymph Nodes: Concerns and Next Steps in Diagnosis

Q: Enlarged Lymph Nodes: Concerns and Next Steps in Diagnosis

Hello Chiun816618@outlook.com： 1. Is it possible that my colorectal carcinoma in situ has metastasized to the cervical lymph nodes? A： "In situ" means that it is localized and does not metastasize. 2. If the ultrasound shows no issues, do I need to go to an ENT

Lymphadenopathy

Hello Doctor: Around October, I experienced sharp pain in my jaw and throat.
Upon pressing, I discovered a hard swollen lymph node near my salivary glands, approximately 2 cm in size.
In November, I was very worried and went to see an ENT specialist and an endocrinologist.
They examined me and performed an ultrasound, concluding that it did not seem malignant and advised me to monitor it, which I have done since then without any changes.
During this period, I also underwent a colon polyp removal surgery on November 2, and the pathology report indicated a highly differentiated tubular villous adenoma, which the doctor classified as carcinoma in situ.
However, on November 23, I had to undergo another colon polyp removal because the previous doctor did not excise it completely.
Prior to the surgery, I had a chest X-ray and an abdominal CT scan, which showed no metastasis to other abdominal organs.
In mid-December, due to a family history of lung adenocarcinoma, I also had a low-dose CT scan, and the report at the end of December indicated a 0.3 cm nodule, which the doctor said could be monitored for now.

Around mid-December, I noticed three or four lymph nodes gradually appearing on the right side of my neck.
Two of them are located in the upper cervical chain lymphatic area, feeling swollen and soft, as if covered by a membrane, making it easier to palpate the lymph nodes, which are mobile.
Another one, which I initially felt was small, has now grown to 0.9 cm (as shown on ultrasound) and is located in the middle cervical chain lymphatic area, above the right clavicle, not in the supraclavicular fossa.
It feels harder but still elastic, with a wider range of mobility, and is very smooth.
When standing, it resembles an oval-shaped mini grenade, but when lying down, it feels smaller and flatter.
The ultrasound while lying down also showed it to be flattened, but I feel it is different from what I feel when standing.
I find it strange that only the right side is affected, and they have been gradually enlarging.
Shortly after, I caught a cold from my child, experiencing coughing and a runny nose, which took about two weeks to resolve without seeing a Western medicine doctor.
Although the lymph nodes have slightly decreased in size, they are still present.
In December, I returned to the ENT and internal medicine specialists for ultrasound examinations of these lymph nodes.
The ENT specialist felt there was no need for aspiration or biopsy, and the internal medicine doctor also believed the shape and appearance did not suggest malignancy, recommending continued observation.
After sharing all this, I would like to ask the doctor: 1.
Is it possible that my carcinoma in situ from the colon has metastasized to the cervical lymph nodes? 2.
If the ultrasound shows no issues, should I go back to the ENT for a nasopharyngoscopy to rule out the possibility of a throat tumor? 3.
If there are no other symptoms, should I arrange for blood tests or more detailed imaging scans? I really want to directly have a biopsy to check!

Douzi, 30~39 year old female. Ask Date: 2024/01/05

Dr. Chen Sirong reply Oncology

Hello [email protected]:
1.
Is it possible that my colorectal carcinoma in situ has metastasized to the cervical lymph nodes?
A: "In situ" means that it is localized and does not metastasize.
2.
If the ultrasound shows no issues, do I need to go to an ENT specialist for a nasopharyngoscopy to rule out the possibility of a throat tumor?
A: It is sufficient to have a check-up during your annual cold season.
3.
If there are no other symptoms, do I need to arrange for blood tests, CT scans, or other more detailed examinations?
A: No, because you mentioned that there have been no changes until now.
The lymph nodes have slightly decreased in size.
If they are shrinking or not enlarging, it is not malignant, and there is no need for a biopsy.
Wishing you a safe and peaceful New Year,
Taoyuan Hospital, Chen Si-Rong

Reply Date: 2024/01/05

More Info

When it comes to enlarged lymph nodes, particularly in the context of your recent medical history, it's understandable to have concerns about their significance and whether further diagnostic steps are necessary. Based on the information you've provided, let's address your questions and concerns systematically.

1. Could the lymph nodes be a result of the colorectal carcinoma?
While it is theoretically possible for colorectal cancer to metastasize to lymph nodes in the neck, it is relatively uncommon for this to occur, especially if the primary tumor has been identified and treated. The lymphatic drainage from the colon typically leads to abdominal lymph nodes rather than cervical nodes. However, given your family history of lung adenocarcinoma and your recent diagnosis of a high-grade tubular adenoma, it is prudent to remain vigilant. The fact that your lymph nodes have been evaluated by specialists who do not suspect malignancy is reassuring, but continuous monitoring is essential.

2. Should I request a nasopharyngoscopy to rule out throat tumors?
If your ENT specialists have assessed your lymph nodes and do not find them suspicious, it may not be necessary to undergo a nasopharyngoscopy at this time. However, if you have persistent symptoms such as throat pain, difficulty swallowing, or any new symptoms, it would be reasonable to discuss this option with your doctor. A nasopharyngoscopy can help visualize the throat and nasopharynx directly, potentially identifying any abnormalities that imaging studies might miss.

3. Is further testing like blood work or scans necessary?
Given that your lymph nodes have been evaluated via ultrasound and deemed non-suspicious, and considering you do not have other concerning symptoms, immediate further testing may not be warranted. However, if you experience changes such as increased size of the lymph nodes, new symptoms, or if you have ongoing concerns, discussing additional imaging studies or blood tests with your healthcare provider could be beneficial. These tests can provide more information about your overall health and help rule out any underlying issues.

4. Desire for a biopsy:
It is completely understandable to want clarity regarding the nature of your lymph nodes, especially given your medical history. If you feel strongly about having a biopsy, you should communicate this to your healthcare provider. A fine needle aspiration (FNA) or excisional biopsy can provide definitive information about the cellular makeup of the lymph nodes and help rule out malignancy. Your doctor can weigh the risks and benefits of this procedure based on your specific situation.

In summary, while your lymph nodes have been assessed and found to be non-suspicious, ongoing observation is key. If you notice any changes or have new symptoms, do not hesitate to reach out to your healthcare provider. They can help guide you through the decision-making process regarding further diagnostic tests or interventions. Remember, open communication with your healthcare team is crucial in managing your health concerns effectively.

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